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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343618630
Report Date: 09/08/2022
Date Signed: 09/08/2022 02:13:47 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/23/2022 and conducted by Evaluator Fabiola Diaz
COMPLAINT CONTROL NUMBER: 03-CC-20220223103834
FACILITY NAME:TIMOFEYEV, NATALIEFACILITY NUMBER:
343618630
ADMINISTRATOR:TIMOFEYEV, NATALIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 729-1148
CITY:ANTELOPESTATE: CAZIP CODE:
95843
CAPACITY:14CENSUS: 6DATE:
09/08/2022
UNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Natalie Timofeyev TIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
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9
Conduct of adult in home poses a health and safety risk for day care children in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
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7
8
9
10
11
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13
Licensing Program Analyst (LPA) Fabiola Diaz arrived at the facility at approximately 1:50 PM and met with licensee Natalie Timofeyev to close a complaint investigation regarding the above allegation. Upon arrival LPA observed 6 children present. Also present was licensee’s husband and mother. It was alleged that conduct of adult in home poses a health and safety risk for day care children in care. The investigation was conducted by Investigator Jami Eaton. During the course of the investigation Investigator Jami Eaton interviewed individuals involved in the allegation. The information provided during the course of the investigation was conflicting and not substantial enough to prove or disprove the allegation. Based on investigator’s investigation although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. There were no Title 22 deficiencies during today’s visit. Appeal Rights were provided to licensee. A notice of site visit was given and must remain posted for 30 days at the facility. Exit interview conducted and report was reviewed with the licensee, and a copy was provided to licensee.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Fabiola DiazTELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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